Does gender modify associations between self rated health and the social and economic characteristics of local environments?

OBJECTIVES: To examine whether area level socioeconomic disadvantage and social capital have different relations with women's and men's self rated health. METHODS: The study used data from 15 112 respondents to the 1998 Tasmanian (Australia) healthy communities study (60% response rate) nested within 41 statistical local areas. Gender stratified analyses were conducted of the associations between the index of relative socioeconomic disadvantage (IRSD) and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, political participation, social trust, trust in institutions) and individual level self rated health using multilevel logistic regression analysis before (age only) and after adjustment for individual level confounders (marital status, indigenous status, income, education, occupation, smoking). The study also tested for interactions between gender and area level variables. RESULTS: IRSD was associated with poor self rated health for women (age adjusted p<0.001) and men (age adjusted p<0.001), however, the estimates attenuated when adjusted for individual level variables. Political participation and neighbourhood safety were protective for women's self rated health but not for men's. Interactions between gender and political participation (p = 0.010) and neighbourhood safety (p = 0.023) were significant. CONCLUSIONS: These finding suggest that women may benefit more than men from higher levels of area social capital.     

Does dental coverage fit into the health care reform?

Thirty-seven million Americans have little or no access to health care either because of cost, preexisting conditions, or other underwriting decisions. In addition, more than 128 million Americans have no dental coverage.     

Does the addition of information on genotype improve prediction of the risk of melanoma and nonmelanoma skin cancer beyond that obtained from skin phenotype?

The authors quantified improvement in predicting cutaneous malignant melanoma, basal cell carcinoma, and squamous cell carcinoma of the skin made possible by information on common variants of the melanocortin-1 receptor gene (MC1R) in a 1998-1999 population-based case-control study of subjects aged 20-59 years of northern European ancestry in Tasmania, Australia. Melanin density at the upper inner arm was estimated by spectrophotometry. DNA samples were genotyped for five MC1R variants: Val60Leu, Asp84Glu, Arg151Cys, Arg160Trp, and Asp294His. Among controls (n = 267), variant carriers, versus noncarriers, had lower (p < 0.01) mean melanin concentrations. Increased risk conferred by genotype was restricted mainly to those with the darkest skins: for subjects with at least 2% melanin, the odds of carrying each additional variant were higher for cutaneous malignant melanoma (n = 39; odds ratio = 1.45, 95% confidence interval: 0.87, 2.44), basal cell carcinoma (n = 35; odds ratio = 1.86, 95% confidence interval: 1.14, 3.02), and squamous cell carcinoma (n = 42; odds ratio = 2.67, 95% confidence interval: 1.50, 4.74) cases than for controls (n = 135). Adding MC1R information to prediction based on age, sex, and cutaneous melanin increased the area under the receiver operating characteristic curve by 1.4% (cutaneous malignant melanoma), 3.2% (basal cell carcinoma), or 2.0% (squamous cell carcinoma). The improvement in prediction was probably too small to be valuable in a clinical setting.     

Eating disorder features and quality of life: Does gender matter?

Purpose

This study examined whether gender moderates the associations between eating disorder features and quality-of-life impairment and whether eating disorder features can explain gender differences in quality of life in a sample of undergraduate students.

Methods

The SF-12 Physical and Mental Component Summary Scales were used to measure health-related quality of life (HRQoL), and the Eating Disorders Examination Questionnaire (EDE-Q) was used to quantify eating disorder behaviors and cognitions. These self-report forms were completed by undergraduate men and women (n = 709).

Results

Gender was a significant predictor of mental HRQoL, such that women in this sample reported poorer mental HRQoL than men. Eating disorder cognitions were the strongest predictor of undergraduate students’ mental and physical HRQoL, while binge eating negatively predicted their physical HRQoL only. Gender was not found to moderate the associations between eating disorder features and HRQoL, and eating disorder cognitions were found to mediate the association between gender and mental HRQoL such that a proportion of the difference between undergraduate men and women’s mental HRQoL was attributable to eating disorder cognitions.

Conclusion

This study provided further evidence of the significant impact of eating disorder features, particularly eating disorder cognitions, on HRQoL. The finding that gender did not moderate the relationships between eating disorder features and HRQoL indicates the importance of investigating these features in both men and women in future research.

     

Bicycle helmet campaigns and head injuries among children. Does poverty matter?

OBJECTIVES: To assess the impact of a community based bicycle helmet programme aimed at children aged 5-12 years (about 140,000) from poor and well off municipalities. METHODS: A quasi-experimental design, including a control group, was used. Changes in the risk of bicycle related head injuries leading to hospitalisation were measured, using rates ratios. RESULTS: Reductions in bicycle related head injuries were registered in both categories of municipalities. Compared with the pre-programme period, the protective effect of the programme during the post-programme period was as significant among children from poor municipalities (RR= 0.45 95%CI 0.26 to 0.78) as among those from richer municipalities (RR=0.55 95%CI 0.41 to 0.75). CONCLUSION: Population based educational programmes may have a favourable impact on injury risks in poor areas despite lower adoption of protective behaviours.     

Are the associations between diet and C-reactive protein independent of obesity?

OBJECTIVES: To determine the relative magnitude of the effect of dietary factors on circulating C-reactive protein (CRP) levels, controlling for BMI. METHODS: 1808 men and 2269 women attended the 1994/95 follow-up survey from the Busselton Health Study, Australia. A composite diet score was derived from a short questionnaire. Height and weight were measured. RESULTS: After controlling for BMI, CRP levels were associated with red meat intake (males only, p=0.001), fruit intake (males p<0.0001, females p=0.029), potato intake (males p=0.008, females p=0.029), using wholemeal bread (males p=0.014, females p=0.018), using polyunsaturated fats as a spread and in cooking (females only, p=0.005), and rarely or never adding salt to food (males p=0.012, females p=0.004). The overall diet score was significantly (negatively) related to CRP in males (p<0.0001) and females (p<0.0001). The relative decrease in CRP from a moderately healthy diet, compared to an unhealthy diet was 37% in men and 24% in women. This was comparable to a difference in BMI of at least 3 kg/m(2) (or a difference in weight of approximately 9 kg for a person of average height). CONCLUSION: A healthy diet and lower weight have independent beneficial effects of similar magnitude on CRP levels.     

Different social contexts of leisure-time physical activity: Does the association with depressive symptoms differ?

Our aim was to analyze the association between different social contexts of physical activity (PA) and depressive symptoms. Data from the Brazilian National Health Survey (PNS) (n = 59,722; ≥18 years) were used. The social context of leisure-time PA [classified according to the higher probability of being practiced in group (group PA) or individually (individual PA)] and total PA time were self-reported. Depressive symptoms were evaluated through the Patient Health Questionnaire-9. Chronological age, ethnicity, educational status, employment status, tobacco smoking, alcohol ingestion, and soft drink consumption were co-variables. Logistic regression models were applied for association analyses. Among men, individual and group PA were associated with lower depressive symptoms compared with the no PA group among men [Individual: OR:0.59 (95%CI:0.40 to 0.86); Group: OR:0.42 (95%CI:0.29 to 0.59)]. Sensitivity analysis revealed that men involved in group PA were 40% [OR:0.60 (95%CI:0.38 to 0.94)] less likely to present elevated depressive symptoms when compared with individual PA. In females, no differences in depressive symptoms were observed comparing individual PA [OR:0.89 (95%CI:0.71 to 1.11)] and group PA [OR:0.86 (95%CI:0.54 to 1.37)] with the no PA group. Activities that are more likely to be a group PA demonstrated a stronger association with low depressive symptoms among men, but not women.     

Does risk factor epidemiology put epidemiology at risk? Peering into the future

The multiple cause black box paradigm of the current risk factor era in epidemiology is growing less serviceable. This single level paradigm is likely to be displaced. The signs are that the growing strength of molecular epidemiology on the one side, and of a global epidemiology based on information systems on the other, will come to dominate epidemiology and segregate it into separate disciplines. At the same time, the links with public health interests grow weaker. A multilevel ecoepidemiology has the potential to bind these strands together.     

How specific are the relationships between eating disorder behaviors and perfectionism?

Perfectionism is associated with several mental disorders, including depression, anxiety, and eating disorders. The goal of this study was to test the specificity of the associations between perfectionism facets and eating disorder behaviors, by examining whether neuroticism and conscientiousness mediated or moderated associations between these variables. Participants from a representative community sample (N = 407; 47% female) completed questionnaires assessing perfectionism, neuroticism, conscientiousness, and eating disorder behaviors. Neuroticism partially mediated associations between binge eating, restraint, body dissatisfaction, and maladaptive perfectionism facets. Neuroticism did not mediate associations between restriction and achievement striving perfectionism facets. Conscientiousness did not mediate any associations between perfectionism facets and eating disorder behaviors, yet Doubts about Actions interacted with conscientiousness to predict body dissatisfaction. Results indicate that neuroticism is key for understanding general risk factors that lead to myriad internalizing disorders, whereas maladaptive perfectionism has limited usefulness as a specific risk factor for eating disorder behaviors. Nevertheless, there is a unique association between dietary restraint and achievement striving dimensions of perfectionism that cannot be explained by higher-order personality traits.     

Does living by the coast improve health and wellbeing?

It is often assumed that spending time by the coast leads to better health and wellbeing, but there is strikingly little evidence regarding specific effects or mechanisms to support such a view. We analysed small-area census data for the population of England, which indicate that good health is more prevalent the closer one lives to the coast. We also found that, consistent with similar analyses of greenspace accessibility, the positive effects of coastal proximity may be greater amongst more socio-economically deprived communities. We hypothesise that these effects may be due to opportunities for stress reduction and increased physical activity.     

Does the choice of neighbourhood supermarket access measure influence associations with individual-level fruit and vegetable consumption? A case study from Glasgow

Background

Anopheles albimanus is among the most important vectors of human malaria in Mesoamerica and the Caribbean Basin (M-C). Here, we use topographic data and 1950?C2000 climate (near present), and future climate (2080) layers obtained from general circulation models (GCMs) to project the probability of the species?? presence, p(s), using the species distribution model MaxEnt.

Results

The projected near-present distribution parameterized with 314 presence points related well to the known geographic distribution in the study region. Different model experiments suggest that the range of An. albimanus based on near-present climate surfaces covered at least 1.27 million km² in the M-C, although 2080 range was projected to decrease to 1.19 million km². Modeled p(s) was generally highest in Mesoamerica where many of the original specimens were collected. MaxEnt projected near-present maximum elevation at 1,937?m whereas 2080 maximum elevation was projected at 2,118?m. 2080 climate scenarios generally showed increased p(s) in Mesoamerica, although results varied for northern South America and no major range expansion into the mid-latitudes was projected by 2080.

Conclusions

MaxEnt experiments with near present and future climate data suggest that An. albimanus is likely to invade high-altitude (>2,000?m) areas by 2080 and therefore place many more people at risk of malaria in the M-C region even though latitudinal range expansion may be limited.     

Does the choice of neighbourhood supermarket access measure influence associations with individual-level fruit and vegetable consumption? A case study from Glasgow

ABSTRACT: BACKGROUND: Previous studies have provided mixed evidence with regards to associations between food store access and dietary outcomes. This study examines the most commonly applied measures of locational access to assess whether associations between supermarket access and fruit and vegetable consumption are affected by the choice of access measure and scale. METHOD: Supermarket location data from Glasgow, UK (n = 119), and fruit and vegetable intake data from the 'Health and Well-Being' Survey (n = 1041) were used to compare various measures of locational access. These exposure variables included proximity estimates (with different points-of-origin used to vary levels of aggregation) and density measures using three approaches (Euclidean and road network buffers and Kernel density estimation) at distances ranging from 0.4 km to 5 km. Further analysis was conducted to assess the impact of using smaller buffer sizes for individuals who did not own a car. Associations between these multiple access measures and fruit and vegetable consumption were estimated using linear regression models. RESULTS: Levels of spatial aggregation did not impact on the proximity estimates. Counts of supermarkets within Euclidean buffers were associated with fruit and vegetable consumption at 1 km, 2 km and 3 km, and for our road network buffers at 2 km, 3 km, and 4 km. Kernel density estimates provided the strongest associations and were significant at a distance of 2 km, 3 km, 4 km and 5 km. Presence of a supermarket within 0.4 km of road network distance from where people lived was positively associated with fruit consumption amongst those without a car (coef. 0.657; s.e. 0.247; p0.008). CONCLUSIONS: The associations between locational access to supermarkets and individual-level dietary behaviour are sensitive to the method by which the food environment variable is captured. Care needs to be taken to ensure robust and conceptually appropriate measures of access are used and these should be grounded in a clear a priori reasoning.     

Does instillation of chlorhexidine into the bladder of catheterized geriatric patients help reduce bacteriuria?

A randomized prospective trial compared the effect on the bacterial flora of the urine of the instillation of chlorhexidine or of normal saline into the bladder of two groups of elderly patients with indwelling urinary catheters. There was no reduction in urinary bacterial count in either group of patients.